The halls of Capitol Hill are buzzing this week as Congress returns from the two week Easter Recess, President Trump and Congressional Democrats continue negotiations to keep the federal government open beyond Friday, April 28, the Wicker-Stabenow Health Center funding letter closes, and House Republicans consider bringing the American Health Care Act back from the dead.

We here at Health Centers on the Hill want advocates to be up to date on all the latest developments. To that end, you can get a more in-depth look at these and other policy issues impacting health centers by joining our April Policy and Advocacy Webinar, this Wednesday at 3:30 PM eastern. Click here to register.

Shutdown Fight

With just three days left to negotiate a deal before the federal government shuts its doors and temporarily suspends nonessential services on Friday at midnight, Democrats on Capitol Hill and the Trump administration have yet to find agreement on the remainder of the FY17 spending package. At issue for the Trump administration and Congressional Democrats, respectively, are a $1.5 billion down payment to begin construction of the southern border wall, and $7 billion to fund cost sharing reduction (CSR) payments for participants in the federal healthcare exchanges with incomes below 250% of the poverty level. For more on CSR payments and their role in marketplace coverage, see a recent post here on our sister blog, The Policy Shop.

Until the inclusion of recent demands to fund the border wall and continue CSR subsidies for health exchange enrollees, Congressional leaders were able to iron out roughly 200 controversial provisions in the FY17 continuing resolution. Congressional leaders in both parties were able to put partisan affiliations aside to avoid the traditional political stumbling blocks of Planned Parenthood funding and budget cuts at various federal agencies, including the Environmental Protection Agency and State Department, which have held up previous negotiations. However, the recent addition of border wall funding and CSR payments have left Congressional Democrats and the Trump administration at loggerheads.

Most recently, Mick Mulvaney, the Director of the Office of Management and Budget OMB and President Trump’s chief negotiator on the FY17 spending package, proposed a dollar-for-dollar exchange to fund both the border wall and CSR subsidies; however, that offer has drawn sharp rebuke from Congressional Democrats who support a permanent extension of the CSR payments. We’ll continue to send out updates this week negotiations between the Trump administration and Congressional Democrats progress. Please keep an eye on NACHC’s social media accounts and blog for up-to-the-minute news about the FY17 spending package.

****Editor’s Note****

Negotiations between the Trump administration and Congressional Democrats are still ongoing, showing glimmers of a possible breakthrough to avert a government shutdown before Friday’s midnight deadline. President Trump’s $1.5 billion request for border wall funding has been rescinded ‒ removing one of the largest obstacles leaders in Washington faced to strike an agreement that keeps the federal government open.

However, a deal isn’t guaranteed. As of Wednesday afternoon, Republicans and Democrats are still wrestling with several issues including $7 billion for CSR subsidies, at least a $15 billion increase in defense funding, $500 million to alleviate Puerto Rico’s looming Medicaid crisis, and $1.3 billion for coal miners’ health benefits. At Wednesday’s morning press briefing, Speaker of the House Paul Ryan suggested that the $7 billion for CSR subsidies have no place in Congress’ annual spending bills ‒ implying that the Trump administration, and not Congress, is responsible for funding them. As we move closer to Friday’s midnight deadline, it looks increasingly likely that Congress will pass a week-long extension in order to reach a deal next week.

****End Note****

Wicker-Stabenow Health Center Funding Letter

If Friday’s shutdown drama doesn’t provide enough excitement for you, there’s also another deadline on the horizon: the Wicker-Stabenow Health Center Funding Letter closes out Thursday, April 27. Currently, 46 Senators have signed on board to support health center funding in FY18; but that’s still well short of the 62 who joined last year. (Click here to see if your Senator has signed, or if he/she signed last year but not yet this year) We need your help to make sure Congress knows the importance of ending the health center funding cliff well before September 30, and why providing robust funding for health centers in FY18 is important. Click here to send a note to your U.S. Senators and ask them to add their names to the Wicker-Stabenow Health Center Funding Letter.

Reviving the American Health Care Act

House Republicans spent much of the Easter Recess discussing potential changes to their Affordable Care Act repeal bill, the American Health Care Act, which failed to receive a vote on the House several weeks ago. In a concerted effort to bring additional members of the House Freedom Caucus on board the American Health Care Act, Rep. Tom MacArthur (R- NJ) proposed an amendment to relax many of the ACA’s current consumer protections. Specifically, it would allow states to opt out of certain ACA requirements that everyone be charged the same amount for health care coverage, regardless of their health status. In exchange for waivers, states would be required to establish a new risk-sharing program to help cover the sickest and most costly patients, who could be denied coverage by insurers due to the waiver.

Lastly, a change made to the bill before Congress departed for the Easter Recess provided $15 billion for states to establish their risk-sharing programs; however, a recent analysis of Rep. MacArthur’s proposal suggests states will need between $3.3 billion and $17 billion each year in order to make the proposal viable. Long story short, Rep. MacArthur’s amendment is expensive!

House Republicans have yet to decide whether to move forward with Rep. MacArthur’s amendment, and several moderate Republican members of the House of Representatives have already expressed concerns about the potential impact, and cost, of removing health care protections for vulnerable Americans.

Wrapping Up

Although progress on the House ACA repeal effort is expected to grind to a halt this week due to Congress’ focus on the looming government shutdown, the Federal Affairs team here at NACHC will continue to publicly express the importance of immediately fixing the health center funding cliff, preserving the structure and integrity of Medicaid, and providing predictability for health centers. Click here to read NACHC’s statement on the American Health Care Act, and please continue to follow our activities on Twitter and Facebook for the latest updates on the House’s ACA repeal effort.